MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s November agenda were:

  • congressional request on health care provider consolidation
  • increasing the supply of primary care physicians
  • redesigning the Medicare Advantage quality bonus program
  • reforming the benchmarks in the Medicare Advantage payment system
  • considerations for plans serving low-income beneficiaries in the restructuring of Medicare Part D
  • post-acute care spending under the Medicare Shared Savings Program

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.  Those recommendations, in turn, can have a major impact on the nation’s private safety-net hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

No Primary Doc Shortage for Medicare Patients – at Least Not Yet

Medicare patients currently have adequate access to primary care physicians, according to the Medicare Payment Advisory Commission.

But that could change in the near future, MedPAC warns.

Amid long-term concerns about whether there are enough primary care doctors, a new MedPAC report found that there are even fewer primary care doctors than most people believe.  MedPAC reached this conclusion after finding that approximately one out of every five doctors thought to be working as primary care physicians now labor instead as hospitalists.  As a result, growth in the number of primary care physicians has been negligible during the current decade.

Counteracting this shift are two trends:  first, Medicare patients appear to be seeing their primary care doctors less than in the past:  3.7 visits a year in 2017 versus 4.1 in 2013; and other practitioners, such as physician assistants and nurse practitioners, are seeing patients more frequently – 1.8 such encounters a year in 2017, up significantly from 1.1 in 2013.

Despite this, MedPAC is concerned that if the current trend of minimal growth in the supply of primary care physicians continues, Medicare beneficiaries may lack appropriate access to primary care in the future.

This issue is especially important to private safety-net hospitals because many serve especially large numbers of low-income Medicare patients who often face challenges in gaining access to the care they need.

Learn more from the Healthcare Dive article “As docs ditch primary care to become hospitalists, MedPAC warns of shortage” or see the new MedPAC report “Updates to the methods used to assess the adequacy of Medicare payments for physician and other health professional service.”

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among issues on MedPAC’s October agenda of potential interest to private safety-net hospitals were:

  • restructuring Medicare Part D
  • updates to the methods used to assess the adequacy of Medicare’s payments for physicians and other health professionals
  • population-based outcome measures: avoidable hospitalizations and emergency department visits
  • aligning benefits and cost-sharing under a unified payment system for post-acute care

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among issues on MedPAC’s September agenda were:

  • context for Medicare payment policy
  • the effects of Medicare Advantage “spillover” on Medicare fee-for-service spending and coding
  • evaluation of the hospital readmissions reduction program
  • Medicare indirect medical education (IME) policy, concerns, and considerations for revising

These issues are important to most private safety-net hospitals.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year.

The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation:

  • inpatient- and outpatient drug- and device related payment proposals
  • proposed changes in the hospital area wage index
  • the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet
  • the long-term hospital prospective payment system

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

See MedPAC’s letter to CMS here.

See NASH’s reponse to the same CMS proposed regulation here.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s April agenda were:

  • Expanding the use of value-based payment in Medicare
  • Medicare Shared Savings Program performance
  • Redesigning the Medicare Advantage quality bonus program
  • Increasing the accuracy and completeness of Medicare Advantage encounter data
  • Evaluating patient functional assessment data reported by post-acute-care providers
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services
  • Options to increase the affordability of specialty drugs and biologics in Medicare Part D
  • Improving payment for low-volume and isolated outpatient dialysis facilities

Many of these issues are important to private safety-net hospitals.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

 

MedPAC Offers Recommendations on FY 2020 Rates, More

Last week the Medicare Payment Advisory Commission released its annual report to Congress.  Included in this report are MedPAC’s Medicare rate recommendations for the coming year.  They are:

  • hospital inpatient rates – a two percent increase
  • hospital outpatient rates – a two percent increase
  • physician and other health professional services rates – no update
  • skilled nursing facilities – no 2020 increase
  • home health agencies – a five percent rate reduction
  • inpatient rehabilitation facilities – a five percent rate reduction
  • long-term-care hospital services – a two percent increase
  • hospice services – a two percent rate reduction

MedPAC also recommended that the Centers for Medicare & Medicaid Services replace its current array of hospital quality programs with a new, streamlined “hospital value incentive program,” or HVIP, that would replace the Hospital Inpatient Quality Program, the Hospital Readmissions Reduction Program, the Hospital-Acquired Condition Reduction Program, and the Hospital Value-Based Purchasing Program.

MedPAC’s recommendations are binding on neither the administration nor Congress but its views are highly respected and often find their way into new laws, new policies, and new programs.

Learn more about MedPAC’s annual recommendations to Congress in the full MedPAC report or the MedPAC fact sheet that accompanies the recommendations’ release.

MedPAC: Overhaul Medicare Quality Programs

Medicare would implement major changes in its hospital quality programs under a proposal approved by the Medicare Payment Advisory Commission.

Fierce Healthcare reports that the proposal adopted by MedPAC for recommendation to Congress and the Centers for Medicare & Medicaid Services

…would essentially lump together several existing programs that measure quality—the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program and the Hospital-Acquired Condition Reduction Program—into the Hospital Value Incentive Program (HVIP). 

It would also eliminate the existing Inpatient Quality Reporting Program.

Under the MedPAC proposal,

Performance across five domains—readmissions, mortality, spending, patient experience and hospital-acquired conditions—would be converted to HVIP “points.” Those points would be used to distribute the pool of funds instead of penalizing hospitals as the current system does. 

MedPAC estimates that hospitals might experience a 3.3 percent net increase in Medicare payments under its proposal; the current, multi-program approach would yield as much as a 2.8 percent increase.

MedPAC will encourage Congress and CMS to act quickly and implement its proposal in 2020.

Private safety-net hospitals have not always felt fairly treated by some of these quality programs, maintaining that their patients face socio-economic obstacles that make them more challenging to serve than the patients most community hospitals serve and that comparisons with most community hospitals – often the basis for quality ratings and either financial penalties or rewards – are inappropriate.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Learn more about the MedPAC hospital quality proposal and other recent MedPAC proposals in the Fierce Healthcare article “MedPAC recommends overhaul to Medicare’s hospital quality programs.”

MedPAC Mulls Direct Billing for Nurse Practitioners, Physician Assistants

Medicare would permit nurse practitioners and physician assistants to bill directly for their services under a proposal being considered by the Medicare Payment Advisory Commission.

Currently such services are billed as “incident to” physician services, but according to a report in Becker’s Hospital Review,

MedPAC staff told commissioners there are problems with “incident to” billing because it “obscures policymakers’ knowledge of who is providing care for beneficiaries,” “inhibits accurate valuation of fee schedule services,” and “increases Medicare beneficiary spending.”  Staff also said that physician assistants and nurse practitioners increasingly practice outside of primary care.

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

MedPAC commissioners are expected to vote on the recommendation next month.

Learn more about the billing recommendation in this article in Becker’s Hospital Review.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s December agenda were:

  • Medicare payments for physician and other health professionals services
  • payments for ambulatory surgical centers
  • payments for hospital inpatient and outpatient care
  • Medicare’s hospital quality incentive program
  • payments for skilled nursing facilities
  • payments for long-term care hospitals
  • payments for inpatient rehabilitation facilities
  • the Medicare Advantage program

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.